Dear Readers,

Welcome to the latest edition of "The Overhead Athlete's Edge," your go-to source for cutting-edge insights and strategies to optimize performance and prevent injuries in overhead athletes. This edition zeroes in on a pressing concern for young baseball and softball players: Little League Elbow. Our expert analysis will help you understand the causes, recognize the symptoms, and implement effective strategies to keep your players in the game and performing at their best.

In Focus: Physiology of Little League Elbow in the Youth Throwing Athlete

Little League Elbow is, in medical terms, medial epicondyle apophysitis. Let’s break down what that means. In children and adolescents, typically between the ages of 8 and 15 when the bones and joints are developing, repetitive stress is placed on the medial (inside) part of the elbow, at the epicondyle, the round bony part at the end of the upper arm bone. Too much stress results in pain and swelling at the apophysis, which is the growth plate on the medial epicondyle. The growth plate is normally soft and has a “gap” from the rest of the bone in order to accommodate how our body changes as we grow. When we reach a certain age, typically puberty, growth plates turn into hard bones, the gap closes, and bone length growth stops. The part of the elbow that becomes sore in Little League Elbow is the attachment site of the Ulnar Collateral Ligament (UCL aka Tommy John Ligament) as well as several muscle tendons, which are together essential in providing stability and preserving biomechanics of the throwing arm.

Expert Insights: Should I Play Through Little League Elbow?

Can I keep playing? That’s the big question. My answer is on a case-by-case basis. Are you in the Little League World Series or at an important showcase? Can you manage your pain during gameday, and continue to perform at your peak levels? Were you able to tolerate your bullpen session and warm up activities this week? Then, maybe, yes, as long as you understand the risks that come with it.

However, generally, I would recommend focusing on longevity of your baseball career, opting for rest, recovery, and gradual return to a throwing program under the guidance of your sports performance physical therapist or athletic trainer. Risks of playing through injury include:

• More severe injury such as permanent damage to the growth plate and excessive stress to the UCL

• Delayed healing and prolonged recovery time

• Compensatory injuries at the shoulder due to altered mechanics from avoiding pain at the elbow

• Reduced accuracy and velocity when throwing, affecting individual and team performance

**Pro Tip: When you get imaging of the sore elbow, make sure to request imaging of the opposite elbow as well, so you can compare and contrast the quality of the growth plates. We can often determine extent of the injury and how aggressive we can be in recovery by what the area looks like on the injured vs uninjured arm.

Technique Spotlight: Functional Wrist and Forearm Strengthening

This series of exercises is beneficial for the muscles of the elbow, forearm, and shoulder because it trains everything together. Many traditional wrist and elbow exercises isolate each joint individually, with the resistance in the hand (think holding a weight and doing wrist extensions), versus from different angles. Here we are teaching our shoulder, wrist and hand to move as one unit.

Ask the Expert: I Keep Hearing That Better Core Strength Will Lessen the Chance of Elbow Injuries in My Pitchers. Why is this the case?

All overhead athletes use their entire body to throw. The throwing motion starts from the stance of your feet, to rotation at the hips, alignment and rotation through the spine, up through the shoulder, elbow, and eventually release through the fingers. At The Training Room, we provide a “head-to-toe” evaluation for all of our overhead athletes, especially when targeting elbow and shoulder pain with throwing. We make sure to analyze lower body stability, as the hips generate much of the power in a throw, and closely assess core stability, as the core muscles transfer this energy up through the torso and into the arm. The ability to rotate the trunk quickly is actually a significant factor in pitch velocity. Any dysfunction or weakness in a thrower’s chain of energy transfer can place excessive stress on the elbow, as an athlete attempts to continuously increase velocity and workload.

Success Story: Overcoming Adversity

In this issue our client spotlight focuses on Spencer, who came to us as a high school pitcher who had finished traditional outpatient physical therapy after undergoing a surgical procedure to his elbow. Spencer was back to “normal” activity but still had pain and difficulty with throwing.

Spencer’s backstory: He originally had pain on the inside of his elbow with numbness that traveled down to his pinky following release of the ball. He feared that he was destined for the dreaded Tommy John Surgery (UCL repair), but fortunately following imaging and an exploratory surgery, the doctors determined that his UCL was perfectly fine, and that his ulnar nerve was actually the issue. The surgeon moved this nerve in a procedure called “ulnar nerve transposition.”

In a head-to-toe evaluation, Dr. Bell broke down Spencer’s strength, mobility, and full body movement and throwing mechanics. Spencer progressed through a guided throwing program and is now working his way into the starting rotation on his college team.

Good luck this fall season!

Stay Connected: Join Our Community

Connect with our vibrant online community of fellow overhead athletes, coaches, and sports enthusiasts by giving us a follow on Instagram @TheTrainingRoomOC. Share your experiences, seek advice, and stay updated on the latest developments in sports performance physical therapy for overhead athletes. Together, we can elevate our performance and achieve new heights in our respective sports.

Closing Note:

Thank you for embarking on this journey with us through the world of sports performance physical therapy for overhead athletes. We hope you found this issue of "The Overhead Athlete's Edge" insightful and empowering. Stay tuned for more valuable information and inspiration in our next edition. Until then, keep honing your skills, pushing your limits, and trusting the process!

Best regards,

Dr. Sam